The effect of thoracic epidural analgesia on postoperative liver and renal fonction and haematological parameters in open heart surgery

Aim:Surgical stress, pain and related organ dysfunctions are common problems in open heart surgeries, affecting morbidity and mortality. An open heart surgery can induce systemic and organ specific complications such as heart failure, liver and kidney dysfunction, impaired hemostatic system, neurological and cognitive dysfunction. Thoracic epidural analgesia (TEA) is a highly effective procedure for relieving acute pain after surgery or severe trauma to the chest, as it has excellent pain control and high satisfaction potential for patients. In addition to providing good pain control, TEA is an analgesia method that has positive effects on many organ systems and is frequently used in open heart surgery. The aim of this study is to investigate the effects of TEA on postoperative liver and kidney functions and hematological parameters, sedation and pain levels of patients, extubation time, length of stay in intensive care and mortality. Material and Methods:Patients who underwent open heart surgery between 2008-2018 were included in the study. The patients were divided into two groups as epidural analgesia group (Group E) and intravenous analgesia group (Group I) according to the analgesia method applied based on file records. The demographic data of the patients, hemogram values, blood biochemistry (ALT, AST, creatine, glucose, INR, albumin, sodium, potassium, calcium), mobilization times, additional sedation and additional analgesic requirement, intensive care and hospital stay, and mortality rates were analyzed. Results:During the time period we determined the study, the data of 1280 of 1369 patients who had undergone open heart surgery were available. There was no significant difference between the groups in terms of age, gender, body mass index, and ASA classification. Postoperative analgesia and sedation need was less in Group E patients than Group I. Blood glucose level was significantly higher in Group I than Group E, while creatinine values were higher in Group E than Group I. No significant difference was found in terms of other parameters, length of stay in the ICU, mobilization time and mortality. Conclusions:TEA; It is an effective analgesia method that can be preferred in patients undergoing open heart surgery due to its positive effects. As shown in this study, TEA reduces the need for postoperative sedation and analgesia. Although TEA provides easier blood glucose regulation, kidney and liver functions should be monitored closely, considering that organ hypoperfusion may occur due to hemodynamic effects.